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METHOD OF OPTIMIZING HEALTHCARE SERVICES CONSUMPTION

  • US 20100217625A1
  • Filed: 05/04/2010
  • Published: 08/26/2010
  • Est. Priority Date: 12/06/2002
  • Status: Active Grant
First Claim
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1. A method of optimizing healthcare services consumption, including the steps of:

  • assessing a healthcare situation of an employer who provides healthcare benefits to a population that resides and consumes healthcare services in a health economic zone;

    identifying a first group of patients from the population likely to generate expensive healthcare claims relative to other patients in the population based on data representing past healthcare claims generated by the population;

    periodically determining whether patients in the first group have obtained healthcare services that satisfy predetermined requirements;

    identifying a first group of providers in the health economic zone who provide high quality, cost efficient healthcare services relative to other providers in the health economic zone based on data representing past practice patterns of the first group of providers and the other providers;

    prompting patients who have not obtained healthcare services that satisfy the predetermined requirements to obtain additional healthcare services to satisfy the predetermined requirements from providers in the first group of providers; and

    responding to healthcare requests from the population by determining whether a-patients submitting requests are seeking to obtain healthcare services from providers in the first group of providers, and for a patient requesting services from one of the other providers, taking an action through human intervention to urge the submitting patient to obtain the requested healthcare services from a provider in the first group of providers.

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